WASHINGTON, DC – House Democratic Whip Steny H. Hoyer (MD) made the following statement today to the American Medical Association’s National Advocacy Conference:
“It’s an honor to follow Majority Leader Frist, who truly is an ambassador for your noble profession – which a civilized, healthy society depends on. ‘Look to your health,’ said Izaak Walton nearly 400 years ago, ‘and if you have it, praise God and value it next to conscience.’
“Today, you are in Washington at a key moment. We stand at a crossroad in regard to our nation’s fiscal health. And the consequences for our health care system and the health of the American people could not be higher. You have every right to expect us, the nation’s elected representatives, to make tough choices. But this year, we are not.
“Last week, we had one of our biggest votes of the year in the House of Representatives on the fiscal 2005 Budget Resolution. Some believe this vote is merely symbolic. But, in fact, it is a statement of our values and our priorities. The Republican Budget Resolution that narrowly passed the House last Thursday, I believe, not only was irresponsible, but also a betrayal of those values. Allow me to explain.
“Three and one-half years ago, we had a projected 10-year budget surplus of $5.6 trillion. But today, we are back on the cusp of a fiscal crisis, with a record budget deficit this year of more than half a trillion dollars and estimated deficits over the next decade of more than $4 trillion.
“Let me put this in perspective: This year’s deficit is so large that we could wipe out all non-defense discretionary spending-spending for heath care, education, veterans, homeland security-and we’d still run a deficit of more than $100 billion!
“We are not making the tough choices. We are ignoring them. We are like a patient with a highly treatable condition who risks calamity through reckless indifference. Rather than honestly addressing this record deficit spending, my Republican friends have prescribed another round of tax cuts that make it virtually impossible to address crucial national issues such as helping the uninsured and will force our children to pay our bills.
“The House Republicans’ budget would actually increase the projected deficits over the next five years by nearly $250 billion. And even as they’re calling for more tax cuts, they’re proposing deep, unacceptable cuts to health care. They would require more than $2 billion in cuts to Medicaid, jeopardizing heath care for millions. Now is not the time to cut Medicaid! Not with so many states is fiscal crisis. Not with every state cutting provider payments.
“They would fail to fund the Family Opportunity Act, bipartisan legislation that would allow families with disabled children to buy into Medicaid. They would allow more than $1 billion in SCHIP funding to expire on September 30th. And they would ignore the needs of the public health system, cutting funds for public health next year by $1.1 billion below the 2004 enacted level. NIH, for example, would face a cut of $553 million below the 2004 enacted funding level.
“In sharp contrast, House Democrats have offered a budget that would restore all of these cuts, while still providing tax relief for working families, protecting Social Security and bringing our budget back to balance within eight years.
“Now, I ask you: With nearly 44 million Americans without health insurance today, an increase of 4 million since 2001, how can we even be thinking of cutting health care programs? We are the richest, most talented, most powerful nation on earth. And yet, one in six of us have no health insurance. That’s not only a national embarrassment; it’s a national scandal.
“Every one of us knows that an ounce of prevention is worth a pound of cure. And right now, there are too many uninsured Americans who are waiting too long to be treated, and as a result they are sicker once they do seek care – which only increases costs.
“Today, I would ask you to consider supporting two Democratic proposals that are designed to expand access to health care. Congressman Dingell and Senator Kennedy have introduced the ‘Family Care Act,’ which would allow parents of eligible children to qualify for SCHIP. And Congressmen Brown and Stark have introduced a Medicare ‘buy-in’ bill that would give people between the ages of 55 and 64 the option of purchasing Medicare coverage. Each bill targets a segment of the population most in need of health insurance.
“On the other hand, I am greatly concerned that some of the proposals offered by my friends on the other side would do little to increase coverage and could possibly even reduce it. HSAs, for example, threaten to erode current employer coverage and AHPs could make insurance even less affordable for many.
“The President’s contribution in this area seems limited to the creation of a refundable tax credit - $1,000 for individuals and $3,000 for families. But this proposal is inadequate, at best, especially when you consider that premiums for comprehensive family plans can cost more than $20,000 a year. The AMA’s proposal to provide individual tax credits while also reforming the group market to provide more affordable rates is certainly a preferable approach.
“Now, I know that you have specific priorities beyond health care funding and the uninsured. Let me touch briefly on two, medical liabilities and antitrust relief.
“Are there too many frivolous lawsuits in our legal system today? Yes, I believe there are. Should we take action to prevent them? Yes, we absolutely should. Among other things, we need to make sure that judges have real power to sanction lawyers and litigants who bring such cases and that they exercise it.
“You do not practice medicine so that you can look at patients as potential legal adversaries; so that you can pay exorbitant liability premiums; so that you have a Damocles sword hanging over your head 24 hours a day. You choose the medical field to help people, and we need to make sure that you can do what are trained to do without having your attention diverted by liability fears.
“However, I must be forthright with you: I am concerned that one proposed ‘cure’-capping non-economic damages is the wrong prescription for this condition. About caps, one thing seems indisputable: Patients with the worst injuries will be the ones most affected. Their damages, after all, are likeliest to exceed the cap.
“But it also troubles me, when in the course of this important debate, some insurers say they have no intention of reducing your premiums if caps are enacted. What that says to me, as a lawmaker, is that we need to take a very hard look at how insurers set premiums. When I hear about your cost of doing business, I understand your deep concern and anxiety. And when I read about physicians leaving their practice of medicine, I know that a problem exists.
“However, this is a complex problem that is only going to be solved when we, one, crack down on those who abuse the legal process; two, root out medical errors; and three, ensure that your premiums truly reflect the risk. This organization’s proactive efforts to reduce medical error for example, through the establishment of the National Patient Safety Foundation- are an absolute step in the right direction.
“Now, there is another important issue upon which we can and should come together, and that’s your effort to enact anti-trust relief.
“In too many parts of the country, a few large health insurers dominate the market. And the anti-trust law limits your ability to negotiate with insurance companies, even on issues of patient care. The American people would be appalled if they knew that insurers presented you with one-sided contracts with egregious terms. And they would be incensed if they knew that many require you to provide the cheapest care.
“We need to level the playing field. We need to provide real anti-trust relief. You need to be able to deal with insurers without fear of automatically violating anti-trust laws. And that’s why I join you in supporting H.R. 1120, the Health Care Antitrust Improvements Act, which will clarify the application on antitrust laws to negotiations between groups of doctors and insurance companies.
“Let me conclude by offering three brief thoughts. First, despite the challenges faces America’s health care system today, we should never lose sight of the fact that we have the greatest, most advanced health care system in the world. And that is due, in great measure, to the dedication, the intelligence, the commitment, and the vision of men and women like you.
“In one sense, the medical profession has become a victim of its own success. The American people believe that there is nothing physicians employing modern medicine cannot do; that if they become ill, you will make them well, regardless of the condition. But we know that’s simply unrealistic; that medicine is not only a science, but also an art. And thus, like any art that depends on human beings, absolute guarantees cannot be obtained.
“Second, while it’s natural for us to focus on the issues that confront us today, we need to look up over the horizon and prepare for those that are sure to appear tomorrow. For example, as baby boomers age, as life expectancy increases, and as health care systems see more chronic illness, the demand for long-term care will increase exponentially. If we do not begin a dialogue on this issue now in the medical community, in Congress, among the American people- we are going to be faced with yet another crisis in a few years.
“And finally, I want to urge you – our nation’s physicians, one of the most powerful, respected advocates for health care – to stay engaged here in Washington. We need to hear from you on a wide range of health care issues. You are on the front lines, day to day.
“You are the real experts when it comes to the realities of our heath care system. And it’s imperative that we receive your values input and advice. Thank you for all you do for the American people every single year.”